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A Pill Available in Mexico Is a Texas Option for Abortion

Pharmacies in Nuevo Progreso, Mexico, just across the Texas border, sell an abortion pill without a prescription.Credit
Michael Stravato for The New York Times

McALLEN, Tex. — At the Whole Woman’s Health center here, a young woman predicted what others would do if the state’s stringent new abortion bill approved late Friday forces clinics like this one to close: cross the border to Mexico to seek an “abortion pill.”

“This law will lead a lot more women to try self-abortion,” said Jackie F., a 24-year-old food server and student who was in the health center last week for a follow-up medical examination after getting a legal abortion.

The woman, who requested that her last name not be used to avoid stigma, was referring to a drug that can induce miscarriages and is openly available in Mexico and covertly at some flea markets in Texas.

In Nuevo Progreso, only yards past the Mexican border, pharmacists respond to requests for a pill to “bring back a woman’s period” by offering the drug, misoprostol, at discount prices: generic at $35 for a box of 28 pills, or the branded Cytotec for $175.

“The women see it as “a pill to make my period come,’” said Andrea Ferrigno, a vice president of Whole Woman’s Health, which runs a network of abortion clinics. “Often in their minds, it’s not abortion.”

On Friday, the Texas Senate gave final passage to one of the strictest anti-abortion measures in the country, legislation championed by Gov. Rick Perry, who rallied the Republican-controlled Legislature after a Democratic filibuster last month blocked the bill and intensified already passionate resistance by abortion-rights supporters.

The law would ban most abortions after 20 weeks of pregnancy and hold abortion clinics to the same standards as hospital-style surgical centers, among other requirements. Its supporters say that the strengthened requirements for clinics and doctors will protect women’s health.

State Senator Glenn Hegar, a Republican and the chief sponsor of the bill in the Senate, said it was not his intent to close abortion clinics, “but to increase the quality of the care.”

Opponents argue that the restrictions are actually intended to put financial pressure on the clinics that perform abortions and will force most of them to shut their doors.

If the new law survives legal challenges, both Whole Woman’s Health in McAllen and the only other abortion clinic in the Rio Grande Valley, in nearby Harlingen, which together perform more than 3,500 abortions a year, will have to shut down, their owners say.

The greatest impact is likely to be among low-income women, who will be less able to make the needed two trips to the nearest clinic that meets the new surgical-center standards, in San Antonio, four hours north.

In the United States, legal medication abortions involve the use, in the first nine weeks of pregnancy, of misoprostol together with a steroid that breaks down the uterine lining. The success rate is more than 95 percent. In addition to requiring many clinics to close, the new Texas law would curb such medication abortions by requiring that the drugs be administered at surgery centers and at what doctors call an outdated dosage.

Misoprostol taken alone is less effective, but the drug is more readily available because it is prescribed to prevent gastric ulcers.

But health experts worry about its unmonitored use.

Lacking health insurance or fearing the stigma of being seen at an abortion clinic, thousands of Texas residents every year are already making covert use of this pill or trying other methods to induce abortions on their own, according to Dr. Dan Grossman, an obstetrician in the San Francisco Bay Area and vice president of Ibis Reproductive Health, a nonprofit research group.

When used properly in the early weeks of pregnancy, misoprostol, which causes uterine contractions and cervical dilation, induces a miscarriage about 85 percent of the time, according to Dr. Grossman. But many women receive incorrect advice on dosage and, especially later in pregnancy, the drug can cause serious bleeding or a partial abortion, he said.

The looming limits on legal abortion follow deep cuts in state support for family planning. Planned Parenthood clinics here in Hidalgo County do not perform abortions, but in 2010 provided subsidized contraception to 23,000 men and women at eight centers; as financing dried up, four of them have been closed. This year, the group will serve only 12,000 clients, and other organizations have not taken up the slack, said Patricio Gonzales, chief executive of the Hidalgo County chapter of Planned Parenthood.

If legal abortions become inaccessible in this part of the state, Mr. Gonzales said, “Planned Parenthood may have to step up” and try to raise $1.5 million or more to build a new surgery center that meets the requirements of the new law.

Lucy Felix, a community educator here with the National Latina Institute for Reproductive Health, said that many of the women she works with do not have legal residency and cannot drive north in Texas through Border Patrol checkpoints or even cross the southern border to buy the pill directly for fear that they may not be able to return to their families in Texas.

“The only option left for many women will be to go get those pills at a flea market,” Ms. Felix said. “Some of them will end up in the E.R.”

The two abortion clinics in the Rio Grande Valley say that the cost of meeting ambulatory surgical center standards would be prohibitive. They also doubt that they could find nearby hospitals that would grant admitting privileges to the abortion doctors, another element of the new law.

“They will close us down,” said Dr. Lester Minto, who owns the Reproductive Services clinic in Harlingen, which performs 1,500 to 2,000 abortions each year for a price of about $400.

In a tour of the Whole Woman’s Health clinic here, Ms. Ferrigno noted some of the design and equipment requirements in the new law that would force the clinic to shut down. The clinic, part of a chain in Texas and other states, performs about 1,900 abortions a year using doctors that fly in from other states.

The clinic, like most in Texas, performs abortions only through the first 15 weeks of pregnancy, using medications or a suction method that takes 10 to 15 minutes and involves no incisions. The center uses donations to offer subsidies to many women, Ms. Ferrigno said.

The suite does not have the wide hallways required of a surgery center to facilitate the movement of stretchers in an emergency. In nine years and thousands of abortions, she said, the McAllen clinic has sent only two patients to the hospital, both for readily-treated bleeding.

With plush recliners, a Georgia O’Keeffe flower print on the wall and herbal tea, the center’s recovery room resembles a small first-class lounge.

Ambulatory surgery centers, in contrast, must have large, hospital-style recovery rooms, with medical equipment on the walls. Patients must rest on gurneys, separated by ceiling-mounted curtains. The herbal tea would not be allowed.

To enter the McAllen clinic, women must cross a gantlet of protesters. Florine deLeon, 72, was out front last week with her husband, both of them fingering rosary beads.

“We’re praying for all the babies,” she said. If pregnancies are unwanted, she said, the crisis pregnancy center down the street could set up an adoption.

A version of this article appears in print on July 14, 2013, on page A1 of the New York edition with the headline: In Mexican Pill, A Texas Option For an Abortion. Order Reprints|Today's Paper|Subscribe